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Deadline Looms for SGR Appeal

March 11, 2015

With the year-long patch set to expire on April 1, 2015, Congress must pass legislation to prevent a 21 percent pay cut to Medicare physicians. The Medicare Sustainable Growth Rate (SGR) system serves as a means for the Centers for Medicare and Medicaid Services (CMS) to regulate spending on Medicare physician services. For the past several years, the formula used as part of the SGR system has recommended that payments for Medicare physicians be cut drastically. If this were to happen, many physicians would be forced to leave the Medicare system, causing a large gap in patient care. To avoid this situation, Congress has stepped in with temporary fixes to avoid these cuts; however, a permanent fix has yet to be determined.

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act of 2014, which made permanent changes to how physicians who perform advanced imaging services are paid by connecting it to appropriate use criteria. These permanent changes were included as part of the temporary one-year patch to the SGR system.

Despite these changes, cuts to medical imaging remain as a concern. The current estimated price of repeal is $142 billion. If this were to happen, Congress would need to find spending offsets and imaging is perennially in danger. While SNMMI is actively encouraging Congress to pass a permanent repeal without imaging cuts, another patch remains the most likely scenario.

SNMMI will continue to monitor the situation and provide updates as they occur.